Clinical Neurophysiology & Epilepsy Fellowships

Overview

The intent of this program track is to provide a strong foundation in clinical epileptology and in the technical, interpretive and clinical aspects of electroencephalography and evoked potentials such that the fellow would be able to direct an epilepsy program and an EEG/EP laboratory.

Both programs rely on case-based learning to achieve their educational objectives. Clinical experience is complemented by a series of didactic lectures, an array of clinical and scientific weekly conferences, and a journal club. Fellows also gain teaching experience in their interactions with Neurology residents, medical students, and allied health professionals.

First year fellows are enrolled in the ACGME-accredited Clinical Neurophysiology training program while second year fellows are enrolled in the ACGME-accredited Epilepsy training program. Completion of the full track qualifies participants to take the American Board of Psychiatry and Neurology Added Certificate in Clinical Neurophysiology examination as well as the American Board of Psychiatry and Neurology Added Certificate in Epilepsy examination. 

The service includes an inpatient consultation service, an active outpatient epilepsy clinic, an epilepsy monitoring unit, an epilepsy surgery program, a Pediatric Epilepsy Program directed by Dr. Thiele, and an active epilepsy research program including both clinical and basic science research approaches to the problem of chronic epilepsy. In addition to offering advice on the medical management of seizure disorders, and evaluation for the surgical management of such problems, the Epilepsy Service also provides the opportunity for patients to enroll in investigational treatment protocols.

Curriculum

While the curriculum is mixed throughout the fellowship experience, the first year will emphasize clinical neurophysiology while the second year will emphasize clinical epileptology in accordance with ACGME guidelines.

Clinical Experience

On the Epilepsy Service, the fellow will be responsible for:

1. Performing inpatient consultations on patients with epilepsy or related problems under the supervision of a staff epileptologist
2. Supervising the evaluation of inpatients admitted to the Epilepsy Monitoring Unit in conjunction with staff physicians and the neurology resident staff
3. Attending Adult or Pediatric Epilepsy Clinic once per week (depending on the Fellow’s primary interest) and First Seizure Clinic as required, and Pediatric Epilepsy Clinic (for Adult Epilepsy Fellows) or Adult Epilepsy Clinic (for Pediatric Epilepsy Fellows) as desired
4. Performing electrocorticography under the supervision of a clinical neurophysiologist
5. Supervising intracarotid amobarbital (Wada) testing
6. Assisting in the didactic and interactive teaching of neurology house staff with regard to epilepsy
7. Participating in clinical or basic research protocols involving patients on the Epilepsy Service
8. Organizing the weekly Surgical/Medical Epilepsy Conference

The Mass General Epilepsy Monitoring Unit is equipped with a state-of-the-art fully networked Xltek digital video-EEG system. Three adult beds, one pediatric bed, and one portable unit are used for data acquisition. All studies can be reviewed on-line on dedicated review stations located throughout the clinical neurophysiology laboratory, the neurology clinic, and the Epilepsy Service office suite. Monitoring studies include pre-surgical localization studies using extracranial electrodes (70%), intracranial electrodes (10%), and diagnostic studies (20%) in both adults (75%) and children (25%). (All percentages are approximate).

Clinical Neurophysiology Laboratory

Approximately 40% of the fellow's time will be devoted to the Clinical Neurophysiology Laboratory where the fellow will be responsible for:

1. Assisting the technologists with all problems arising in the EEG/EP laboratory and intensive monitoring units relating to the acquisition of reliable data from patients
2. Assisting the first-year neurology resident rotators (6 weeks) in learning basic EEG/EP interpretations and clinical correlations
3. Providing preliminary interpretations of all routine EEG/EPs done in the EEG laboratory each day and reviewing these the following morning with the staff neurophysiologist
4. Assembling EEG/EP, clinical and radiographic materials for two weekly conferences, one to review test results on their patients with the ward team, the other to discuss interesting or problematic tests performed in the laboratory during the previous week
5. Giving occasional lectures to the technologists. In addition, the fellow may pursue a clinical neurophysiology research project that can be completed during the course of the fellowship

The Clinical Neurophysiology Laboratory has 7 EEG and 2 EP recording rooms and performs about 3500 routine adult and pediatric (including premature) EEGs, ambulatory EEGs, and 300 pattern VEPs, brainstem auditory EPs, and upper and lower limb SEPs per year, primarily for evaluation of neurologic problems. EEG equipment is state-of-the-art digital Xltek equipment and is networked with the monitoring equipment described above. The sleep laboratory uses the same rooms in the evening. An EMG laboratory is contiguous to the EEG laboratory. Patient investigations are coordinated between these units when appropriate.

Research Experience

Extensive clinical and laboratory facilities are available to support the research efforts of the Epilepsy Service. Fellows may use elective time to pursue research opportunities. Current research projects include:

• Studies of investigational anti-epileptic drugs
• Studies of functional imaging techniques including 15O PET and functional echo-planar MRI imaging with intraoperative correlation
• Magnetic resonance spectroscopy studies of patients with focal and generalized epilepsy
• Neuropathological studies of developmental abnormalities in pediatric epilepsy
• Studies of magnetoencephalography and its application in diagnosis of focal and generalized epilepsies,
• Studies of language organization in the presence of structural and anatomic lesions using fMRI
• Anatomic and biochemical studies in human surgical material and in animal models of chronic epilepsy (In the Epilepsy Research Laboratory directed by Dr. Cole) and
• Multimodal microphysiology studies of human cortex using laminar electrodes and high-density microelectrode arrays implanted in patients undergoing pre-surgical investigation (Under the direction of Dr. Cash)

Clinical Neurophysiology Research

There are extensive computer facilities available for EEG/EP work. Current research projects include:

• Pathophysiology of epileptic phenomena in humans as revealed by MR spectroscopy and fMRI and simultaneous EEG
• Dipole source analysis of benign and abnormal epileptiform transients in normal subjects and patients with epilepsy
• EPs in CNS diseases - generator sources as revealed by human clinico-pathologic correlations - pathophysiology of diseases as revealed by EPs - diagnostic and therapeutic implications of EPs
• Central motor conduction with transcranial magnetic stimulation - studies in normal subjects and patients with neurologic diseases

How to Apply

Applicants should send a curriculum vita, a letter describing long-term interests and career objectives, and three letters of reference to Dr. Douglas Maus, Dr. Andrew J. Cole and Fellowship Coordinator Erica Ratti. Administrative questions and requests for general information should be directed to Joanna Richards.